Abstract：
BACKGROUND: First Ray Instability (FRI) and especially hypermobility leads to the collapse of the medial longitudinal arch\'s structural framework, which reduces the foot\'s ability to become a rigid lever for propulsion, resulting in progressive foot deformities. Early detection of FRI with prompt intervention helps prevent degenerative foot deformities. Various manual, device-based and radiographic diagnostic tests for FRI quantification have been described in the literature. We aim to conduct an up-to-date, comprehensive, systematic review of the literature reporting on diagnostic tests to evaluate FRI.
METHODS: Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests.
RESULTS: 18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one.
CONCLUSIONS: Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.
METHODS: Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests.
RESULTS: 18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one.
CONCLUSIONS: Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.
摘要：
背景：第一射线不稳定性（FRI），尤其是过度活动导致内侧纵向弓的结构框架塌陷，这降低了脚成为推进的刚性杠杆的能力，导致进行性足部畸形。早期发现FRI并及时干预有助于预防退行性足部畸形。各种手册,文献中已经描述了FRI定量的基于设备和射线照相诊断测试。我们的目标是进行最新的，全面,系统评价FRI诊断试验的文献报告。
方法：电子数据库(Medline，Embase和PubMed）和参考书目清单一直搜索到2021年5月，以进行评估FRI诊断测试的研究。使用MeSH术语进行文献检索。作者筛选了所有产生的摘要。根据纳入和排除标准进一步全面评估选定的文章。对相关研究进行了定性评估，并根据测试分组为表格。
结果：确定了18,176项研究。纳入了32篇全文供评估。根据评估标准排除了十篇文章。18项研究被纳入定性评估：两项研究描述了手动诊断测试，三个评估设备驱动的测试，六项图像引导研究和七项比较研究评估一项新测试与一项既定测试。
结论：定义FRI的金标准测试需要改进。手动测试表现出显著的主观可变性。射线照相试验,虽然准确，执行复杂而繁琐，因此,没有广泛应用。与仪器相比，背侧标尺显示出混合的结果并显示出可变性。重点是评估外翻（HV）的FRI。需要更多的研究来调查缺乏HV的FRI。
方法：电子数据库(Medline，Embase和PubMed）和参考书目清单一直搜索到2021年5月，以进行评估FRI诊断测试的研究。使用MeSH术语进行文献检索。作者筛选了所有产生的摘要。根据纳入和排除标准进一步全面评估选定的文章。对相关研究进行了定性评估，并根据测试分组为表格。
结果：确定了18,176项研究。纳入了32篇全文供评估。根据评估标准排除了十篇文章。18项研究被纳入定性评估：两项研究描述了手动诊断测试，三个评估设备驱动的测试，六项图像引导研究和七项比较研究评估一项新测试与一项既定测试。
结论：定义FRI的金标准测试需要改进。手动测试表现出显著的主观可变性。射线照相试验,虽然准确，执行复杂而繁琐，因此,没有广泛应用。与仪器相比，背侧标尺显示出混合的结果并显示出可变性。重点是评估外翻（HV）的FRI。需要更多的研究来调查缺乏HV的FRI。
